Abstract
Since some authors have stated a certain role for so-called “free fatty acids” (FFA) in the pathogenesis of AP and the subsequent systemic complications we tried to find possible correlations between FFA, pancreatitis and lung injury using a rat model. AP was induced by intraductal infusion of two different concentrations of glycodeoxycholic acid (GDOC 17 mmol and 34 mmol). An equal number of animals had only cannulation of the pancreatic duct without infusion and served as controls (GDOC-control). In another experimental model iv.-infusion of oleic acid (OA) was used to create severe lung injury comparable to human ARDS. In this model control animals received iv.-infusion of saline solution only (SAL). At 2,6,12,24 and 48 hours the animals were sacrificed and blood was collected for determination of FFA, amylase and pO2. The pancreas and lungs were removed for histologic examination and the lungs were weighed. GDOC-34 animals developed severe pancreatitis with hemorrhage and necrosis. Histology of the lungs showed edema, inflammatory infiltrates, hemorrhage and thickening of the alveolar membrane in GDOC-34 rats as well as in OA-animals. In contrast, there was only pancreatic edema until 24 hours in the GDOC 17 group and less severe histological changes in the lungs. Amylase, FFA, pO2 and lung weight were directly influenced by the different kinds of treatment. Furthermore, FFA correlated positively with the levels of amylase and lung weight and negatively with pO2. Infusion of OA alone also caused an increase in levels of amylase with pancreatic edema and focal necroses in some animals. These results show that it was possible to create different degrees of severity of AP which was in concordance with different degrees of morphologic changes and dysfunction in the lungs. FFA values correlated significantly with the clinical course as well as with increasing amylase, lung weight and decreasing pO2.
Highlights
The incidence of pulmonary complications associated with acute pancreatitis has been reported to range from 15-70% 1-3
In 20-60% of patients acute pancreatitis is associated with lung injury, which may progress to alterations consistent with ARDS1-6
We have examined the occurrence and time course of pulmonary changes in an experimental model of acute pancreatitis as well as after i.v. infusion of oleic acid
Summary
The incidence of pulmonary complications associated with acute pancreatitis has been reported to range from 15-70% 1-3. With hemorrhagic necrotizing pancreatitis a third of all patients are threatened by respiratory insufficiency that will require intensive care and mechanical ventilation. Up to 20% of all patients die of respiratory failure4’5. In a large series reported by Hollender and coworkers, 19% of patients died of respiratory insufficiency within the first 3 days after onset of the disease[6]. Rosen M.D., Hanusch Medical Center, Department of Surgery, Heinrich Collinstr.
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